New Construction Service Application

Site Information

Site Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

Estimated Date of Service Installation(Required)

Building Type(Required)

Frame Construction

Mobile Home

Other

Dwelling Type(Required)

Single

Duplex

Commercial

Apartment Complex

Home/Business Owner Information

Name of Owner(Required)

First Last

Phone(Required)

Country Phone Number

Email(Required)

Current Mailing Address(Required)

Street Address City State ZIP Code

Builder/Contractor Information

Company Name(Required)

Contact Person(Required)

First Last

Company Address(Required)

Street Address City State ZIP Code

Phone(Required)

Country Phone Number

Fax(Required)

Billing Information

Who should be billed for electric/water installation?(Required)

Homeowner

Builder

Who should be billed for electric/water usage during construction?(Required)

Homeowner

Builder

Electric Service Requirements

Is temporary service required?(Required)

Yes

Estimated date temporary service is needed(Required)

If temporary service is required, who pays additional cost?(Required)

Service Size(Required)

100 amps

200 amps

Other

Service Type(Required)

Underground service will not be installed when ground is frozen - Arrangements must be made with BWL

Underground

Overhead

Type of Heat(Required)

Electric Heat

Natural Gas

Oil

Boiler

Voltage(Required)

120/240

Other

Electrical Contractor Information(Required)

Water Service Information

Standard Residential meter requires meter horn with 8 inch spread and 1-inch nuts and a 3/4-inch meter bore. Meter must be installed in a heated and easily accessible space. After service is installed, Brodhead Water and Light is only responsible for the water service lateral from the main to the curb shutoff at the property line.

Service Size(Required)

3/4-inch

1-inch

Other

Meter Location Requirements

Check any that many be a conflict(Required)

Private Underground Facilities

Brodhead Water and Light will be excavating or boring your property in order to install your electric/water service line. To avoid damage to any private facilities (underground tanks, lighting, sewer, sprinkler, dog fence, water, etc.) by Brodhead Water and Light, you are responsible for clearly and accurately identifying all private underground facilities with paint and/or stakes. Brodhead Water and Light must be informed of all private facilities and proposed construction sites at the time of application. Brodhead Water and Light will not be held responsible for any damage whatsoever to any private underground facility as a result of lack of identification. The cost of any repairs to damaged private underground facilities and any additional expenses due to known or unknown private facilities will be your responsibility. If you need assistance in locating your private underground facilities, you must contact a locating contractor at your expense. Digger's hotline will not help locate privately-owned facilities. Customer acknowledges that Brodhead Water and Light facilities will be attached to the Customer's building and that the attachment of Brodhead Water and Light facilities may affect certain Customer warranty rights. Customer agrees to identify, defend and hold Brodhead Water and Light, its Commission officers, employees and agents harmless from all judgements and claims, including attorney fees, relating in any way to Customers loss of warranty as a result of any action taken on the part of Brodhead Water and Light to install facilities and equipment.

E-Signature(Required)

By signing this form, I certify that I own or am the authorized representative of the owner of the property of the service address(es) indicated in the application and that I have read and understood the above statements regarding locating and marking all private underground facilities. If the proposed installation cannot be completed to confirm with requirements stated above, field changes may result in any increase cost to me.

Date(Required)